Diagnostic Value of 18F-FDG PET for Evaluation of Paraaortic Nodal Metastasis in Patients with Cervical Carcinoma: A Metaanalysis

We assessed the diagnostic performance of F-18-FDG PET in detecting paraaortic lymph node (PALN) metastasis in patients with cervical cancer. Methods: Through a search of MEDLINE and EMBASE (1980 to March 2009), we performed a random-effects metaanalysis. A summary receiver-operating-characteristic curve was constructed using hierarchical regression models. To identify other sources of heterogeneity, regression metaanalysis was performed. Results: Patients (n = 385) from 10 studies were analyzed. Although specificity of F-18-FDG PET was consistent (97%; 95% confidence interval [CI], 93%-99%), sensitivity was low and heterogeneous among the studies (34%; 95% CI, 10%-72%). Although regression metaanalysis did not identify any source to which heterogeneity could be attributed, it revealed a trend of increasing sensitivity according to an increase in the prevalence of PALN metastasis (P = 0.001). In the 5 studies with prevalence greater than 15%, estimated sensitivity and specificity were 73% (95% CI, 53%-87%) and 93% (95% CI, 86%-97%), respectively. With the diagnostic performance, assuming the prevalence of 15%, the calculated false-positive and -negative rates were 35% and 5%, respectively. Conclusion: In detecting PALN metastasis, PET performs acceptably only in populations with a relatively high probability of PALN metastasis. Otherwise, we found no evidence to justify the evaluation of PALN based solely on PET in cervical cancer.